Association between obesity and likelihood of remission or low disease activity status in psoriatic arthritis applying index-based and patient-based definitions of remission: a cross-sectional study
Laure Gossec,
Ana-Maria Orbai,
Josef S Smolen,
Juan D Cañete,
Maarten de Wit,
Laura C Coates,
Uta Kiltz,
Penelope Palominos,
Rossana Scrivo,
Andra Balanescu,
Martin Soubrier,
Lihi Eder,
Umut Kalyoncu,
Emanuelle Dernis,
Ying Ying Leung,
Sandra Meisalu
Affiliations
Laure Gossec
AP-HP, Rheumatology Department, Pitié-Salpêtrière Hospital, Paris, France
Ana-Maria Orbai
Medicine Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
Josef S Smolen
2 Medical University of Vienna, Vienna, Austria
Juan D Cañete
Rheumatology Department, Hospital Clinic and Institut D`Investigacions Biomediques August Pi Sunyer, Barcelona, Spain
Maarten de Wit
Patient Research Partner, EULAR, Zaltbommel, The Netherlands
Laura C Coates
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford and Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, UK
Uta Kiltz
Rheumazentrum Ruhrgebiet, Herne and Ruhr-Universität Bochum, Bochum, Germany
Penelope Palominos
Division of Rheumatology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
Rossana Scrivo
Rheumatology, Sapienza Università di Roma, Rome, Italy
Andra Balanescu
Department of Internal Medicine and Rheumatology, ‘Sf. Maria’ Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Martin Soubrier
Rheumatology, University Hospital Centre Gabriel Montpied, Clermont-Ferrand, France
Lihi Eder
Department of Medicine, Women`s College Research Institute, University of Toronto, Toronto, Ontario, Canada
Umut Kalyoncu
Department of Internal Medicine, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
Emanuelle Dernis
Service de rhumatologie, Centre hospitalier Le Mans, Le Mans, France
Ying Ying Leung
Department of Rheumatology & Immunology, Singapore General Hospital, Singapore
Sandra Meisalu
Department of Rheumatology, East Tallinn Central Hospital, Tallinn, Estonia
Objectives We aimed to evaluate whether obese patients with psoriatic arthritis (PsA) were less likely to be in remission/low disease activity (LDA).Methods We used data from the ReFlaP, an international multi-centre cohort study (NCT03119805), which recruited consecutive adults with definite PsA (disease duration ≥ 2 years) from 14 countries. Demographics, clinical data, comorbidities, and patient-reported outcomes were collected. Remission/LDA was defined as Very Low Disease Activity (VLDA)/minimal disease activity (MDA), Disease Activity in PSoriatic Arthritis (DAPSA) ≤4/≤14, or by patients’ opinion. Obesity was defined as physician-reported and/or body mass index ≥30 kg/m2. We evaluated the association between obesity and the presence of remission/LDA, with adjustment in multivariable regression models.Results Among 431 patients (49.3% women), 136 (31.6%) were obese. Obese versus non-obese patients were older, more frequently women, had higher tender joint and enthesitis counts and worse pain, physical function and health-related quality of life. Obese patients were less likely to be in VLDA; DAPSA remission and MDA, with adjusted ORs of 0.31 (95% CI 0.13 to 0.77); 0.39 (95% CI 0.19 to 0.80) and 0.61 (95% CI 0.38 to 0.99), respectively. Rates of DAPSA-LDA and patient-reported remission/LDA were similar for obese and non-obese patients.Conclusion PsA patients with comorbid obesity were 2.5–3 folds less likely to be in remission/LDA by composite scores compared with non-obese patients; however, remission/LDA rates were similar based on the patients’ opinion. PsA patients with comorbid obesity may have different disease profiles and require individualised management.
